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194 http://dx.doi.org/10.1590/1983-80422021291459
Research
194
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Rev. Bioét. vol.29 no.1 Brasília Jan./Mar. 2021
Revista Bioética
Print version ISSN 1983-8042 | On-line version ISSN 1983-8034
Knowledge and perception of medical students on
legal abortion
Nathália Maria Fonseca Fróes1
, Cláudia Bacelar Batista1
1. Universidade Federal da Bahia, Salvador/BA, Brasil.
Abstract
Abortion is a frequent practice in Brazil and a major cause of maternal mortality. Even under legal
conditions, women face many barriers to access the procedure, often related to physicians’ unfamiliarity
with the legislation. This article assess the knowledge of medical students from Faculdade de
Medicina da Bahia of Universidade Federal da Bahia about the laws that regulate abortion in Brazil
and their perception on the topic. This qualitative cross-sectional study analyzed data collected from
a questionnaire answered by 237 students. Although the participants showed adequate theoretical
knowledge of legal aspects, discrepant and incorrect answers were observed when asked about law
enforcement in situations of legal abortion care, showing that education focused on the topic is required
using multidisciplinary and transversal discussions during the medical course. Finally, we observed that
participants tended to favor decriminalization of abortion.
Keywords: Abortion, legal. Students, medical. Knowledge. Legislation. Public health.
Resumo
Conhecimento e percepção de estudantes de medicina sobre abortamento legal
O abortamento é prática frequente no Brasil e importante causa de mortalidade materna. Mesmo em
condições legais, as mulheres enfrentam diversas barreiras para acessar o procedimento, muitas vezes em
decorrência do desconhecimento de médicos acerca dos marcos regulatórios. Este artigo objetiva avaliar o
conhecimento de estudantes da Faculdade de Medicina da Bahia da Universidade Federal da Bahia sobre
as leis que permitem o aborto no Brasil, bem como a percepção desses estudantes sobre o tema. Trata-se
de estudo de corte transversal com análise qualitativa de dados obtidos pela aplicação de questionário
a 237 estudantes. Apesar de os participantes demonstrarem conhecimento teórico adequado dos aspectos
legais, houve incongruências e erros quando questionados sobre aplicação das leis em situações práticas
de atendimento ao aborto legal. Os resultados demonstram a necessidade de fortalecer a abordagem do
tema durante a graduação, de modo multidisciplinar e transversal. Vale ressaltar, por fim, que se observou
entre os participantes inclinação favorável à descriminalização do aborto.
Palavras-chave: Aborto legal. Estudantes de medicina. Conhecimento. Legislação. Saúde pública.
Resumen
Conocimiento y percepción de estudiantes de medicina sobre el aborto legal
El aborto es una práctica frecuente en Brasil y una importante causa de mortalidad materna. Incluso
cuando cumplen con las condiciones legales, las mujeres enfrentan varias barreras para acceder al
procedimiento, a menudo debido a la falta de conocimiento de los médicos sobre los marcos regulatorios.
Este artículo tiene como objetivo evaluar el conocimiento de los estudiantes de la Facultad de Medicina de
la Universidad Federal de Bahía sobre las leyes que permiten el aborto en Brasil, así como la percepción
de estos estudiantes sobre el tema. Se trata de un estudio transversal con análisis cualitativo de datos
obtenidos mediante la aplicación de un cuestionario a 237 alumnos. Si bien los participantes demostraron
un conocimiento teórico adecuado de los aspectos legales, hubo inconsistencias y errores cuando se les
preguntó sobre la aplicación de las leyes en situaciones prácticas de atención al aborto legal. Los resultados
demuestran la necesidad de fortalecer la enseñanza de la temática durante la graduación, de manera
multidisciplinar y transversal. Finalmente, cabe mencionar que los participantes mostraron una inclinación
favorable hacia la despenalización del aborto.
Palabras clave: Aborto legal. Estudiantes de medicina. Conocimiento. Legislación. Salud pública.
Approval CEP-UFBA 2.406.450

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Knowledge and perception of medical students on legal abortion
Research
According to the technical literature, “abortion”
means interruption of pregnancy until the 20th
to 22nd week, with fetal weight under 500 g 1
.
Frequent practice in Brazil, abortion has major
impact on the health of Brazilian women, being a
major cause of maternal mortality2
.
Due to underreporting, it is difficult to define
the actual magnitude of maternal morbidity
and mortality from illegal abortion in Brazil 3
.
In general, studies use secondary data from
the Brazilian National Health System (SUS)
repositories, such as the Hospital Information
System (SIH/SUS), Live Birth Information
System, SUS Information Department, and
Mortality Information System (SIM). Even with
these limitations, estimates show that more
than 1 million induced abortions occur in Brazil
every year 1
.
According to SIM, 77 maternal deaths from
abortion were reported in 2011, or 4.8% of the
total maternal deaths reported in that year 3
.
As mortality represents only one aspect of
the situation, hospitalization data confirm the
magnitude of the problem. A study that analyzed
SIH/SUS records collected from 1996 to 2012
showed alarming data 4
. Curettage in the abortion
process is the second most common obstetric
procedure in the public health system. This
period showed around 240,000 admissions due
to abortion complications every year, generating
an annual cost of about BRL 45 million for SUS.
Additionally, the annual average unsafe abortion
rate was 17/1,000 at childbearing age women,
at the rate of 33.2 abortions/100 live births 4
. A
study conducted in the state of Pernambuco had
similar results, finding an annual average unsafe
abortion rate of 36.1% of the total of live births 5
.
Given its magnitude, morbidity and mortality
rates, and the high cost on SUS, abortion must
be seen and treated as a public health issue 6
.
When performed under poor conditions and
without adequate professional care, it is called
“unsafe abortion,” causing a higher rate of death
and complications. When carried out by non-
qualified health professionals or third parties,
the procedure becomes a risk factor for iatrogenic
physical injuries, such as perforation of the uterus
and attachments, infection, and hemorrhage.
Another important risk is the potential worsening
of the woman’s psychological health during all
stages of the procedure7
.
Safe abortion, in turn, is a legal procedure
offered by a structured health service by a
trained multidisciplinary team with all the
necessary care to patients 4
. Article 124 of the
Brazilian Penal Code considers a crime against
life to induce abortion in one’s own body or to
consent to it 8
, describing the penalties until
article 127. Article 128 specifies that necessary
abortion should not be penalized, that is, when it
is the only option to save a woman’s life or when
the pregnancy results from rape, if the woman
agrees with the procedure and it is conducted
by a trained physician 8
.
According to Anjos and collaborators 6
,
in 2012 the Federal Supreme Court in Brazil
ruled that women with anencephalic fetuses also
have the right to abortion. The Federal Council
of Medicine 9
published at the time a resolution
describing the diagnosis of anencephaly for
these cases of therapeutic anticipation of
childbirth. But abortion due to anomalies
incompatible with life is not yet allowed by law.
Since the 1980s, Brazilian women have resorted
to the courts to obtain the right to an abortion
in these cases, and most of them have been
authorized to proceed 10
.
In 2013, according to Balogh 11
, the Federal
Council of Medicine submitted a proposal to the
National Congress committee responsible for the
Penal Code reform, defending women’s autonomy
to decide whether to proceed with pregnancy until
the 12th week. But so far, this proposal has not
been analyzed at the legislative level.
In practice, hospitals tend to do the procedure
when the pregnant woman is at risk of death,
but not in the case of abortion due to sexual
violence12
. Rape victims often suffer institutional
violence, as seen in the delay or refusal to provide
care, difficult access or even acts of explicit
discrimination 4
. Because they are not aware of
their rights or do not know the institutions that
offer care, many of these women do not even
access this service13
.
A study that assessed abortion experiences
found that the relationship with the health team
is based on distrust and fear of mistreatment,
scenario that delays the search for medical care

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and generates tension during hospitalization 14
.
Another research identified some of the
reasons that explain the low demand for legal
abortion: emergency contraception obtained
by the victims themselves, lack of knowledge of
public institutions that offer the service in legal
situations, and underreported sexual violence
due to cultural and institutional obstacles 15
.
Denial of care to a victim of sexual violence
is considered an omission, and the physician can
be civilly and criminally penalized for death or
physical and psychological damage caused to
the victim, according to article 135 of the Penal
Code 8,13
. In pregnancy resulting from rape,
the health team must inform the victim about
her right to terminate the pregnancy, identify
her desire to do so or, when the decision is
to carry to term, explain about prenatal care,
possibility of keeping the child or giving the baby
for adoption, etc. 13
Moreover, physicians may claim conscientious
objection to refuse to do the procedure – device
created to preserve their integrity in cases of
moral conflict, allowing them to not carry out
procedures they consider contrary to their
values. This right, however, is not recognized
when no other physician is available to do the
abortion, or when there is a risk of death or
damage to the pregnant woman’s health due to
the omission 16,17
. At the moment immediately
after the violence, given the serious health risks
to the victim, the doctor cannot use this claim
nor demand a police report or a report from the
Forensic Medicine Institute. As such requirements
have no legal basis, they may be considered an
illicit and unethical conduct 13
.
The Penal Code 8
does not require any
document for abortion in cases of sexual violence,
as the victim has no legal obligation to report the
crime to the police; her statement is presumed
to be true, and physicians may not contest it 13
.
Ordinance 1,508/2005 of the Ministry of Health18
regulates the “Procedures for Justification and
Authorization to Interrupt Pregnancy,” a set
of five instruments that must be used in the
service in cases of abortion in pregnancies from
rape 13
. Physicians should not fear lawsuits if
later no relation is found with sexual violence,
as physicians are safeguarded by article 20 of the
Penal Code8
. If the service followed all procedure
precautions, only the woman will respond
criminally in this case13
, with a penalty of one to
three years in prison.
According to article 154 of the Penal Code 8
,
physicians are not allowed to reveal, without
an acceptable reason, any information they
received in their practice and that may cause
harm to someone. It means that maintaining
confidentiality about induced abortion is an
ethical and legal duty, so physicians are not
obliged to report the patient to the authorities.
Failure to observe this rule can lead physicians
to respond to criminal and ethical-professional
lawsuits for any damage caused to the patient1,8,9
.
Doctors may act improperly due to poor
knowledge of abortion legislation, causing
health risks to the patient. The situation is
further aggravated when the professional fears
being morally judged or involved in a criminal
prosecution19
. For this reason, and because it is a
public health issue, besides being a right provided
by law, it is important to discuss the legislation
that regulates abortion in medical schools, as well
as ethical and legal aspects and their practical
application20
.
This study evaluates the knowledge and
perception of medical students about the Brazilian
legislation on abortion. The results obtained
here can contribute to developing strategies to
expand training on this topic, to promote ethical
awareness among professionals and humanized
quality care for women undergoing this delicate
and difficult process.
Method
This is a qualitative, descriptive, cross-
sectional study, with non-probability sampling.
Students from all semesters (training stages) of
the Bahia Medical School at Universidade Federal
da Bahia (FMB-UFBA) voluntarily answered a
structured and self-administered questionnaire.
This instrument was developed using Google
Forms and sent by email to all students enrolled
in the second semester of 2017. Four emails
were sent, respecting a minimum interval of
seven days between them, from January to
March 2018.

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The questionnaires could be answered at any
time and in any place chosen by the interviewee,
with an average duration of 20 minutes. The body
of the email included an informed consent form
and, if the student agreed to participate in the
study, he could access the questions by clicking
the link provided. To maintain data confidentiality,
the respondent identification was not required in
the questionnaire.
No sample size calculation was performed,
since the questionnaire was sent to all FMB-UFBA
students. The sample included 237 students who
agreed to answer the questionnaire. As there
were 1,022 students actively enrolled in the
second academic semester of 2017, the sample
corresponded to 23.2% of the total population.
Of all 237 participants, 16 (6.8%) were in the 1st
semester, 38 (16%) in the 2nd semester, 11 (4.6%)
in the 3rd semester, 18 (7.6%) in the 4th semester,
17 (7.2%) in the 5th semester, 38 (16%) in the
6th semester, 16 (6.8%) in the 7th semester, 18
(7.6%) in the 8th semester, 23 (9.7%) in the 9th
semester, 20 (8.4%) in the 10th semester, 7 (3%)
in 11th semester, 13 (5.5%) in the 12th semester,
and 2 (0.8%) did not provide this information.
The questionnaire contained only objective
questions and was adapted from two previous
studies with physicians and other health
professionals 20,21
. In total, it had 22 questions
divided into four sections (see Appendix).
The first section collected sociodemographic
data, including age, gender, marital status,
religion, family income, and racial group.
The second section addressed the students’
general knowledge on abortion through
statements that should be identified as true
or false; it also identified which curriculum
components the student had studied in academic
activities on the topic. The third section addressed
specific aspects of the legislation on abortion
in Brazil with multiple choice and closed-ended
questions. Finally, the fourth section assessed the
student’s perception about abortion. Data were
organized and analyzed using Microsoft Excel.
Results
Sociodemographic characterization
In total, 237 students answered the
questionnaire. Most were female (61.2%), between
19 and 22 years old (41.1%), single (91.1%), brown
(48.7%), with family income between 5 and
10 minimum wages (26.7%), Catholic (25%) or
without religion (25%). Students from all semesters
answered the questionnaire, with a predominance
of those in the sixth semester (16%).
General knowledge about abortion
Table 1 shows the statements and respective
true (T) and false (F) answers, as well as
absolute numbers and percentages of students
who provided a “true” or “false” answer.
Although most students correctly classified
abortion statements, many were unaware that
abortion is a major cause of maternal deaths in
developing countries (24.9%) and that repeated
abortion procedures may pose risks for future
pregnancies (30%).
Regarding the profile of women who have
abortions, 21.1% of students mistakenly
answered that the women who most frequently
resort to abortion in Brazil usually have exceeded
the desired number of children, and 23.2% were
unaware that most of these women are young.
Most participants (87.8%) agree that reproductive
planning helps prevent induced abortion.
Almost all students believe abortion is a public
health issue (96.2%) and disagree the access
to reproductive planning is adequate in Brazil
(98.3%). Finally, 62% of students considered that
abortion should not be used as a reproductive
planning method.

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Table 1. General knowledge about abortion
Statements
True False
n % n %
In developing countries, abortion is a major cause of maternal deaths. (T) 178 75.1 59 24.9
Repeated abortion with dilation and curettage can pose risks for future
pregnancies. (T)
166 70.0 71 30.0
Women who resort to abortion in Brazil usually have exceeded the desired
number of children. (F)
50 21.1 187 78.9
Most women who resort to abortion in Brazil are young. (T) 182 76.8 55 23.2
Efficient access to family planning helps prevent induced abortion. (T) 208 87.8 29 12.2
Abortion is a public health issue. (T) 228 96.2 9 3.8
Access to family planning promoted in Brazil is adequate. (F) 4 1.7 233 98.3
Abortion should not be used as a family planning method. (T) 147 62.0 90 38
T: true; F: false
Knowledge of abortion legislation
Table 2 shows statements about legal aspects
of abortion in Brazil with their respective answers,
as well as absolute numbers and percentages of
students who answered each statement as “true”
or “false”. Regarding the provisions in the Penal
Code, 92% of the students knew that a physician
performing an abortion procedure is not punished
when the pregnant woman is at risk of death,
94.9% were aware that no punishment is applied
when a pregnancy results from rape, and 91.1%
recognized that no punishment is applied in cases
of diagnosis of anencephaly or brain anomalies
incompatible with extrauterine life. However,
28.3% of students were unaware that abortion is
punished when the pregnant woman’s health is
not at risk. Only 1.7% of students thought that
abortion is not punished when the pregnant
woman is a minor, and 0.8% thought abortion is
not punished when the woman does not wish to
have the child.
Almost all students (98.3%) knew legal
abortion does not require the husband’s consent.
Smaller percentages knew that a police report
(80.3%) or a report from the Forensic Medicine
Institute (82.9%) is not needed. Almost 24% were
unaware that no document is necessary, only the
woman’s testimony.
Regarding the physician’s attitude in case
of suspected illegal abortion, only 51.5% of
students knew that, excepting an acceptable
cause, it cannot be reported, and 89.6% were
aware that it should not be reported to the
police; however, 38.5% believe that it should not
be reported at all. As for recording suspected
illegal abortion, 69.9% of the interviewees knew
that the procedure must be properly recorded
for suitable handling of the case. However,
27.5% mistakenly believed that suspected
illegal abortion should not be noted in medical
records, as the information is confidential, and
4.2% thought medical records should include the
information to support case reporting.
Regarding conscientious objection, 86.8% of
students knew it is a professional right, but that
cannot be claimed on any situation, and 74.8%
were aware that, in situations of legal abortion,
this device cannot be used in the absence of
another physician to do the procedure. Only
30.3% knew that the right to conscientious
objection does not apply in case of complications
resulting from unsafe abortion, and only 50%
knew that this right cannot be claimed when
abortion should be performed due to the
woman’s risk of death.

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Table 2. Knowledge of abortion legislation
Statements
True False
n % n %
According to article 128 of the Brazilian Penal Code and a decision of the Federal Supreme Court of 2012, abortion
performed by a physician is not punished when:
The pregnant woman is at risk of death. (T) 218 92.0 19 8.0
Pregnancy results from rape. (T) 225 94.9 12 5.1
The pregnant woman is a minor. (F) 4 1.7 233 98.3
The woman does not want to have a child. (F) 2 0.8 235 99.2
There is a risk for the health of the pregnant woman. (F) 67 28.3 170 71.7
In cases of fetus with cerebral anomalies incompatible with extrauterine
life. (T)
216 91.1 21 8.9
Legal abortion requires: *a
A police report. (F) 46 19.7 188 80.3
A report from the Forensic Medicine Institute. (F) 40 17.1 194 82,9
The husband’s consent. (F) 4 1,7 230 98,3
No document is required, only the woman’s testimony. (T) 178 76.1 56 23,9
When illegal abortion is suspected, the physician: b
Must report it to the police. (F) 24 10.4 207 89.6
Should not report it in any way. (F) 89 38.5 142 61.5
Cannot report it, except for an acceptable reason. (T) 119 51.5 112 48.5
Should suspected illegal abortion be registered in the medical records? c
Yes, because records are necessary to report the case. (F) 10 4,2 226 95.8
No, because it is confidential information. (F) 65 27,5 171 72.5
Yes, because records support proper care provision and handling of the
case. (T)
165 69,9 71 30.1
About the right to conscientious objection: a
Physicians have the right to conscientious objection, which can be claimed at
any time. (F)
31 13.2 203 86.8
The right to conscientious objection does not apply if abortion is required due
to woman’s risk of death. (T)
117 50.0 117 50.0
The right to conscientious objection does not apply in case of a legal abortion
in the absence of another physician to perform it. (T)
175 74.8 59 25.2
The right to conscientious objection does not apply in case of complications
resulting from unsafe abortion. (T)
71 30.3 163 69.7
T: true; F: false; *some statements were not answered by all participants; a
234 answers; b
231 answers; c
236 answers
Students’ perception about abortion
Most students were in favor of abortion
in different situations, particularly those
circumstances provided by law – rape (93.7%),
risk of death (92.8%), and brain anomalies
incompatible with life (91.1%). Significant
percentages supported the procedure when
there is a health risk (70.5%), when the woman
does not wish to have the child (69.2%), if the
woman faces socioeconomic issues (60.3%),
in case of adolescent pregnancy (54.4%),
and anomalies incompatible with life (51.5%).
Only 2.5% of respondents answered they were
against abortion in any situation.

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For 74.7% of students, the abortion law should
be changed. About 65% believe abortion should
be fully decriminalized, while 56.7% agree that
the law should include more circumstances in
which abortion is legal. But only 38.6% reported
they would do it professionally in the event
of decriminalization; 81.1% think physicians
who practice illegal abortion should not be
punished; 85.8% would not denounce physicians
for such practice; and 80.7% do not consider
recommending abortive medication as a crime,
if no written prescription is provided.
In a hypothetical situation where an
obstetrician is asked to do an illegal abortion,
93.6% agreed that the physician should clarify
the problem to the patient; 25.1% believed
that the physician should fulfill the patient’s
request; and 20.4% said the physician should
try to change the woman’s decision. Only 5.5%
think the physician should recommend another
professional, and 5.1% that the obstetrician
should recommend an abortive medicine.
When asked about the possibility of doing
an abortion in their professional careers,
94.5% stated they would adopt an approach
to support the woman’s feelings. No student
reported they would feel angry with the patient,
but 1.3% reported disapproval of abortion,
and 0.4% said they would keep contact with the
woman to a minimum. Finally, 54.7% believe
that criminalizing abortion creates difficult and
delicate situations for physicians.
For 81% of students, doctors who perform
legal abortion should have specific qualifications;
57.9% report they would work in a reference
service for legal abortion or any other that do
the procedure. Only 40.7% know the reference
center that do legal abortion in the city of
Salvador, Bahia.
Discussion
Most students showed satisfactory general
knowledge on this topic, providing correct
answers to most statements. The result
was similar to that found in a study with
emergency physician assistants in gynecology
and obstetrics 20
. The aspects with higher error
rates refer to the impact on maternal mortality,
complications for future pregnancies, profile of
women who have abortions, and use of abortion
as a family planning method. This shows a lack of
knowledge on the epidemiology of abortion and
its impact on public health and women’s health,
as well as perpetuating the stereotypes about
women who have abortions.
Participants showed good knowledge about
the situations of abortion permitted by law:
more than 90% answered right about the three
circumstances that do not constitute a crime.
A review published in 2013 analyzed Brazilian
studies published from 2001 to 2011 on
knowledge and behaviors of health professionals
regarding abortion and also found adequate
knowledge of legal situations 22
. The same result
was found in a study involving medical students in
Rio Grande do Norte, with over 90% of students
providing correct answers 23
. However, in a
research conducted in a public university in the
state of São Paulo, only about half of participants
provided correct answers to all questions related
to this topic 19
; a research on anencephaly
with physicians from Goiânia found that only
44.3% knew that a physician can perform
therapeutic anticipation of childbirth without the
authorization of the State24
.
The higher error rate found in our study was
related to the health risk for pregnant women,
as 28.3% of students mistakenly believed that
abortion can be done in this case without
punishment; another study obtained similar
results (20.9%) 23
. On the other hand, the most
frequent error found in the literature refers
to the belief that abortion is legal in any case
of severe malformation of the fetus 19,25
. This
mistake probably occurs due to the frequent
court authorizations in such cases, but, excepting
anencephaly, these situations are not allowed by
law 25
. Such misconception may have not been
so prevalent among the students in our study
because the questionnaire listed only brain
anomalies incompatible with extrauterine life.
Regarding the documents required in cases
of rape, most students are aware that no police
report or a report from the Forensic Medicine

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Institute is necessary; however, a significant
number of students (23.9%) are unaware that
the woman’s testimony is sufficient. This seems
to be a recurrent issue in medical training,
for several studies show a negative impact on
professional practice due to lack of knowledge
of legal provisions 20,25,26
. A study with students
also found a gap in this content and highlighted
insufficient attention to the topic during medical
training 19
. Such poor knowledge can lead to
obstacles in patient care.
Other deficiencies were observed in the
knowledge about provisions of the Brazilian
Penal Code 8
and the Code of Medical Ethics 16
,
for instance, regarding confidentiality,
the possibility of case reporting, and inclusion of
induced abortion in medical records. These gaps
seem to be common among physicians22
. Although
most participants in this study were aware of the
limitations of conscientious objection, students
had difficulty identifying practical situations in
which this right cannot be exercised.
In general, the population studied knows
the legal aspects of abortion, but do not know
when and how to apply it. This result may
indicate a lack of dialogue between curriculum
components, that is, the theoretical content
learned in ethical-humanistic disciplines does
not match or is not reinforced in the disciplines
that specifically address training for medical
practice. Expanding the insertion of abortion-
related topics in the curricular components of
clinical and surgical specialties, in gynecology
and obstetrics, through discussions about
clinical cases, problem situations and, above all,
women’s care, can contribute to proper training
of students.
Students’ personal opinions about abortion
Most students agree with abortion in situations
already provided by law, corroborating the
opinion of doctors found in other studies 22,25-27
.
We also observed a favorable opinion in other
circumstances: about two-thirds of students
support abortion when there is a risk for the
pregnant woman’s health, when pregnancy is
unwanted, and if the woman faces socioeconomic
issues. Just over half agree with the procedure in
cases of adolescent pregnancy and fetal anomaly
compatible with life.
This profile contrasted with that of private
college students, also in Salvador, Bahia,
whose agreement was 27% for any case of
anomaly, and 29.9% for voluntary termination
of pregnancy 28
. This contrast may be due to
differences in socioeconomic profile and workload
dedicated to medical ethics. In a literature review
of studies with physicians, Cacique, Passini Junior
and Osis22
observed more similar results, with two
studies showing approvals of 61.4% and 47.4% for
health risk for pregnant women and percentages
below 50% for other situations.
Regarding regulations, most participants
believe that the legislation should be changed, and
around two-thirds believe abortion should be fully
decriminalized. More than 80% of the students
believe that doctors who do illegal abortion should
not be punished nor reported. Moreover, one out of
four students believes that when an illegal abortion
is requested, the physician must fulfill such request.
Such defense for including more circumstances
in which abortion is legal and more permissive
conducts differ from data found in the
literature20,25
, suggesting a possible selection bias
in our study. Since the issue involves taboos and
prejudices, students with more liberal ideas and
who are interested in the topic were probably
more willing to answer the questionnaire.
An interesting fact is that, despite the more
permissive profile, only 38.6% declared that in
their future professional practice they would do
the procedure if abortion was decriminalized,
which shows a certain contradiction. This situation
converges with the literature, which reports a
tendency to increase the number of conscientious
objection claims29
. A survey with students from
medical schools in Piauí showed high rates: 13.2%
of the participants would refuse to do abortions
in case of risk of death for the pregnant woman;
31.6% in cases of anencephaly; and 50.8% in
pregnancy from rape29
. A more serious aspect is
that a significant number of these students would
not recommend another physician for women
seeking care, nor would they advise women
about all possibilities to do abortion. The rates of
conscientious objection are almost twice higher in
situations of rape29
. These results show the impact
that physicians’ moral and personal beliefs have

Rev. bioét. (Impr.). 2021; 29 (1): 194-207
202 http://dx.doi.org/10.1590/1983-80422021291459
Research
on women’s health, which perhaps explains the
discrepancy in students’ opinions and projections
of future practice – a discrepancy also found in
another study28
.
Professionals should not be required to do
something they do not agree with, but physicians
must be aware of their duty to ensure and
facilitate access to refused treatment. A claim of
conscientious objection must be ethically justified,
and not become a strategy to hide prejudices or fear
of lawsuits and moral accusations. Such instrument
cannot be an obstacle for women to have access to
abortion29
. In this sense, 57.9% of the interviewees
stated they would work in a reference abortion
center, but a considerably smaller percentage
would be willing to do legal abortion.
Finalconsiderations
Participants in this study showed knowledge
of Brazilian legislation regarding abortion but had
problems applying the law to practical situations.
Such issue must be addressed in a transversal and
multidisciplinary manner, in relation to clinical
practice, reinforcing exemplary attitudes of
professorsandpreceptorssothat,besidesrespecting
the law in foreseen circumstances, women arriving
at a health service undergoing abortion can be
treated with empathy and solidarity. Such an
approach can help train professionals who will be
better prepared to enforce the reproductive rights
of women, an important part of the comprehensive
healthcare for the female population.
On the other hand, we observed a more liberal
and less discriminatory attitude among students,
perhaps due to the ethical education offered
by the school where this study was conducted,
which offers an ethical-humanistic axis with eight
curricular components that address gender issues,
abortion and conscientious objection, early life,
sexual and reproductive rights, female autonomy,
and support to patient decision on whether or not
to perform legal abortion30
.
The ability to understand the magnitude
and scope of this social phenomenon and find
solutions depends on investment in education
and information, aiming at the critical training of
individuals. Commitment is also required from
citizens and directly involved sectors, such as the
State and health professionals, always observing
basic principles such as democracy, secularity of
the State, gender equality, and human dignity.
Humanized care in the abortion process is part
of the reproductive and sexual rights of women,
and ensuring it is a duty of all health professionals1
.
References
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trends and spatial distribution of unsafe abortion in Brazil, 1996-2012. Rev Saúde Pública [Internet]. 2014
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9. Conselho Federal de Medicina. Resolução CFM nº 1.989, de 10 de maio de 2012. Dispõe sobre o diagnóstico
de anencefalia para a antecipação terapêutica do parto e dá outras providências. Diário Oficial da União
[Internet]. Brasília, p. 308-9, 14 maio 2012 [acesso 30 jan 2020]. Seção 1. Disponível: https://bit.ly/3afMHXv
10. Diniz D. Aborto seletivo no Brasil e alvarás judiciais. Bioética [Internet]. 1997 [acesso 21 jan 2020];5(1):19-24.
Disponível: https://bit.ly/3pfEhDV
11. Balogh H. Conselho Federal de Medicina apoia opção de aborto até o terceiro mês. Folha de S.Paulo
[Internet]. 23 out 2014 [acesso 21 jan 2020]. Disponível: https://bit.ly/3pmNPNC
12. Duarte GA, Osis MJD, Faúndes A, Sousa MH. Aborto e legislação: opinião de magistrados e promotores de
justiça brasileiros. Rev Saúde Pública [Internet]. 2010 [acesso 21 jan 2020];44(3):406-20. DOI: 10.1590/
S0034-89102010005000006
13. Brasil. Ministério da Saúde. Prevenção e tratamento dos agravos resultantes da violência sexual contra
mulheres e adolescentes: norma técnica [Internet]. 3ª ed. Brasília: Ministério da Saúde; 2012 [acesso
30 jan 2020]. Disponível: https://bit.ly/3rPidSk
14. McCallum C, Menezes G, Reis AP. O dilema de uma prática: experiências de aborto em uma maternidade
pública de Salvador, Bahia. Hist Ciênc Saúde Manguinhos [Internet]. 2016 [acesso 21 jan 2020];23(1):37-56.
DOI: 10.1590/S0104-59702016000100004
15. Farias RS, Cavalcanti LF. Atuação diante das situações de aborto legal na perspectiva dos profissionais
de saúde do Hospital Municipal Fernando Magalhães. Ciênc Saúde Colet [Internet]. 2012 [acesso 21 jan
2020];17(7):1755-63. DOI: 10.1590/S1413-81232012000700014
16. Conselho Federal de Medicina. Código de ética médica: Resolução CFM nº 1.931, de 17 de setembro de
2009 [Internet]. Brasília: CFM; 2010 [acesso 30 jan 2020]. Disponível: https://bit.ly/3tOn4oJ
17. Diniz D. Objeção de consciência e aborto: direitos e deveres dos médicos na saúde pública. Rev Saúde
Pública [Internet]. 2011 [acesso 21 jan 2020];45(5):981-5. DOI: 10.1590/S0034-89102011005000047
18. Brasil. Ministério da Saúde. Portaria nº 1.508, de 1º de setembro de 2005. Dispõe sobre o Procedimento
de Justificação e Autorização da Interrupção da Gravidez nos casos previstos em lei, no âmbito do Sistema
Único de Saúde – SUS. Diário Oficial da União [Internet]. Brasília, nº 170, p. 124-5, 2 set 2005 [acesso
12 fev 2021]. Seção 1. Disponível: https://bit.ly/2ZfcPLK
19. Almeida MAS, Amorim FHR, Barbosa IAF, Dias A, Morita I. Legislação brasileira relativa ao aborto:
o conhecimento na formação médica. Rev Bras Educ Méd [Internet]. 2012 [acesso 21 jan 2020];36(2):243-8.
DOI: 10.1590/S0100-55022012000400013
20. Loureiro DC, Vieira EM. Aborto: conhecimento e opinião de médicos dos serviços de emergência de
Ribeirão Preto, São Paulo, Brasil, sobre aspectos éticos e legais. Cad Saúde Pública [Internet]. 2004 [acesso
21 jan 2020];20(3):679-88. DOI: 10.1590/S0102-311X2004000300004
21. Rocha WB, Silva AC, Leite SML, Cunha T. Percepção de profissionais da saúde sobre abortamento legal. Rev.
bioét. (Impr.) [Internet]. 2015 [acesso 21 jan 2020];23(2):387-99. DOI: 10.1590/1983-80422015232077
22. Cacique DB, Passini R Jr, Osis MJMD. Opiniões, conhecimento e atitudes de profissionais da saúde sobre o
aborto induzido: uma revisão das pesquisas brasileiras publicadas entre 2001 e 2011. Saúde Soc [Internet].
2013 [acesso 21 jan 2020];22(3):916-36. DOI: 10.1590/S0104-12902013000300023
23. Medeiros RD, Azevedo GD, Oliveira EAA, Araújo FA, Cavalcanti FJB, Araújo GL, Castro IR. Opinião de
estudantes dos cursos de direito e medicina da Universidade Federal do Rio Grande do Norte sobre o
aborto no Brasil. Rev Bras Ginecol Obstet [Internet]. 2012 [acesso 21 jan 2020];34(1):16-21. DOI: 10.1590/
S0100-72032012000100004
24. Santana MVMC, Canêdo FMC, Vecchi AP. Anencefalia: conhecimento e opinião dos médicos ginecologistas-
-obstetras e pediatras de Goiânia. Rev. bioét. (Impr.) [Internet]. 2016 [acesso 21 jan 2020];24(2):374-85.
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25. Faúndes A, Duarte GA, Andalaft Neto J, Olivatto AE, Simoneti RM. Conhecimento, opinião e conduta de
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[acesso 21 jan 2020];26(2):89-96. DOI: 10.1590/S0100-72032004000200002
26. Faúndes A, Duarte GA, Osis MJD, Andalaft Neto J. Variações no conhecimento e nas opiniões dos
ginecologistas e obstetras brasileiros sobre o aborto legal, entre 2003 e 2005. Rev Bras Ginecol Obstet
[Internet]. 2007 [acesso 21 jan 2020];29(4):192-9. DOI: 10.1590/S0100-72032007000400005
27. Benute GRG, Nonnenmacher D, Nomura RMY, Lucia MCS, Zugaib M. Influência da percepção dos
profissionais quanto ao aborto provocado na atenção à saúde da mulher. Rev Bras Ginecol Obstet
[Internet]. 2012 [acesso 21 jan 2020];34(2):69-73. DOI: 10.1590/S0100-72032012000200005
28. Darzé OISP, Azevêdo BKG. Competências adquiridas durante a formação médica e as opiniões e atitudes
sobre o aborto. Rev Bras Ginecol Obstet [Internet]. 2014 [acesso 21 jan 2020];36(1):5-9. DOI: 10.1590/
S0100-72032014000100003
29. Madeiro A, Rufino A, Santos P, Bandeira G, Freitas I. Objeção de consciência e aborto legal: atitudes
de estudantes de medicina. Rev Bras Educ Méd [Internet]. 2016 [acesso 21 jan 2020];40(1):86-92.
DOI: 10.1590/1981-52712015v40n1e02382014
30. Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Matriz curricular [Internet]. c2021 [acesso
7 mar 2021]. Disponível: https://bit.ly/2PTgBcp
Nathália Maria Fonseca Fróes – Undergraduate – nathaliamfroes@gmail.com
0000-0001-7681-4690
Cláudia Bacelar Batista – PhD – claudia_bacelar@hotmail.com
0000-0003-1925-8813
Correspondence
Nathália Maria Fonseca Fróes – Rua da Paz, 53, Graça CEP 40150-140. Salvador/BA, Brasil.
Participation of the authors
Nathália Maria Fonseca Fróes designed the study, collected and analyzed the data and wrote the
article. Cláudia Bacelar Batista participated as academic advisor in all phases of the study that
originated the text.
Received: 7.28.2019
Revised: 12.9.2020
Approved: 2.3.2021

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Appendix
Questionnaire adapted from Loureiro and Vieira20
and Rocha and collaborators21
Characteristics of students
Age:
( ) 18 years or less ( ) 19 to 22 years ( ) 23 to 26 years
( ) 27 to 30 years ( ) Over 30 years
Gender:
( ) Female ( ) Male
Marital status:
( ) Single ( ) Married ( ) Consensual union
Religion:
( ) Catholic ( ) Evangelical ( ) Spiritualist ( ) Jehovah’s Witness
( ) Umbanda ( ) Buddhism ( ) Afro religion ( ) Other
( ) No religion ( ) Agnostic/atheist
Family income:
( ) Up to 1.5 minimum wage ( ) 1.5 to 3 minimum wages ( ) 3 to 5 minimum wages
( ) 5 to 10 minimum wages ( ) 10 to 30 minimum wages ( ) More than 30 minimum wages
Color:
( ) White ( ) Black ( ) Brown ( ) Indigenous ( ) Asian ( ) Other
Course semester:
( ) 1st Semester ( ) 2nd Semester ( ) 3rd Semester ( ) 4th Semester
( ) 5th Semester ( ) 6th Semester ( ) 7th Semester ( ) 8th Semester
( ) 9th Semester ( ) 10th Semester ( ) 11th Semester ( ) 12th Semester
( ) Not a regular student
Based on your knowledge, write T for true and F for false:
In developing countries, abortion is a major cause of maternal deaths.
Repeated abortion with dilation and curettage can cause risks for future pregnancies.
Women who resort to abortion in Brazil tend to have exceeded the desired number of children.
Most women who resort to abortion in Brazil are young.
Efficient access to family planning helps prevent induced abortion.
Abortion is a public health problem.
Access to family planning promoted is adequate in Brazil.
Abortion should not be used as a family planning method.
Based on your knowledge, write T for true and F for false.
performed by a physician is not punished when (disregard PEC 181/2015, which is still in discussion):
The pregnant woman is at risk of death.
Pregnancy results from rape.
continues...

Rev. bioét. (Impr.). 2021; 29 (1): 194-207
206 http://dx.doi.org/10.1590/1983-80422021291459
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Based on your knowledge, write T for true and F for false.
performed by a physician is not punished when (disregard PEC 181/2015, which is still in discussion):
The pregnant woman is a minor.
The woman does not want to have a child.
There is a risk for the health of the pregnant woman.
In cases of fetus with cerebral anomalies incompatible with extrauterine life.
Legal abortion requires:
A police report.
A report from the Forensic Medicine Institute.
The husband’s consent.
No document is necessary, only the woman’s testimony
When illegal abortion is suspected, the physician:
Must report it to the police.
Should not report it in any way.
Cannot report it, except for an acceptable reason.
Should suspected illegal abortion be noted in the medical records?
Yes, because records are necessary to report the case.
No, because it is confidential information.
Yes, because records support proper care provision and handling of the case.
About the right to conscientious objection:
Physicians have the right to conscientious objection, which can be claimed at any time.
The right to conscientious objection does not apply if abortion is required due to woman’s risk of death.
The right to conscientious objection does not apply in case of a legal abortion in the absence of another physician to do it.
The right to conscientious objection does not apply in case of complications resulting from unsafe abortion.
Personal opinions about abortion
Check as many options you want.
In what situations do you support induced abortion?
Never
Rape
Death risk
Health risk
Anomaly compatible with life
Anomaly incompatible with life
The woman does not want to have a child
Socioeconomic problems
Adolescent pregnancy
continues...
Continuation

Rev. bioét. (Impr.). 2021; 29 (1): 194-207 207
http://dx.doi.org/10.1590/1983-80422021291459
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Personal opinions about abortion
Check as many options you want.
In your opinion:
The abortion law must be changed.
Abortion must be fully decriminalized.
More circumstances in which abortion is legal should be included.
If abortion was decriminalized, you would do it professionally.
Physicians who practice illegal abortion should be punished.
You would report physicians who practice illegal abortion.
You consider recommending abortive medication as a crime, even without prescribing it.
In the future as a health professional, if you have a case of abortion, you:
will have the shortest possible contact time.
will be close to the woman and explain about patient anxieties.
will feel angry with the woman.
will disapprove of the woman’s decision to abort.
You believe illegality will create difficult situations for physicians.
When an obstetrician receives a request for illegal abortion, he must:
Fulfill the request.
Try to change the woman’s decision.
Provide clarification about the problem.
Recommend another physician.
Recommend an abortive medicine.
Would you work in a reference service for termination of pregnancy in cases permitted by law or in another service
that performs abortion?
No.
Yes.
Do you believe physicians who perform legal abortion should have specific qualifications?
Yes
No
Do you know about the reference center for legal abortion in the city of Salvador?
Yes
No
Continuation

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